A group of Republicans and advocacy groups will soon release a proposal intended to spark another push to repeal the Affordable Care Act, resurrecting a potentially volatile issue in the months before the November midterm elections. The proposal, which would give states more control over health policy, is the result of eight months of behind-the-scenes work by a coalition of conservative groups.It reflects the frustration that many GOP lawmakers feel over last year’s failed effort to overturn the ACA, and the challenge Republicans now face in framing a campaign message around health care.

A group of outside conservative groups developing a plan to repeal Obamacare said they would ensure the final product does not allow taxpayer funding to go toward covering abortions. “When our plan is released, it will include strong pro-life priorities as well as recommendations that focus on providing Americans relief from Obamacare’s high costs and lack of choice while helping to heal the broken private small-group and individual insurance markets,” said Marie Fishpaw, Heritage’s director of domestic policy studies, in a statement.

The price of Obamacare benchmark silver plans will rise 15% next year, the Congressional Budget Office said Wednesday in a new report. The CBO also projects about 5 million more people will be uninsured in 2027 than it estimated in September, up to a total of 35 million people. The double-digit premium increase could add fuel to a heated debate over health care and the fate of the Affordable Care Act.

New data from insurance company regulatory filings show that enrollment in the individual health insurance market declined significantly last year—by 10%, or by 1.8 million people. Over the three years prior to the implementation of Obamacare (2011 through 2013), enrollment in the individual market was basically stable. With the introduction of Obamacare, enrollment peaked at 17.7 million in 2015, and then declined to 17.1 million in 2016.The latest data show that, as of the end of 2017, enrollment in individual-market coverage stood at 15.3 million—the lowest level since before Obamacare.

Federal matching funds to states that expanded Medicaid under the ACA fell to 95% in 2017, 94% in 2018 and will fall to 93% next year. Its final drop is to 90% in 2020 and beyond. The resulting increase in state spending for the program might lead to changes in states’ Medicaid programs. Some expansion states are attempting to offset Medicaid spending with new taxes, work requirements, and other initiatives.

A Maine state judge said Thursday that Gov. Paul LePage’s administration has a “duty to enforce” a voter-passed initiative to expand Medicaid to low-income adults. Kennebec County Superior Court Justice Michaela Murphy’s comment came during oral arguments in a lawsuit brought by advocacy groups to force the LePage administration to implement the Medicaid expansion overwhelmingly passed by Maine voters last November. Gov. LePage has said the state does not have the funds to meet its matching spending requirements.

A bipartisan group of House lawmakers on Thursday moved to delay Obamacare’s health insurance tax for another year. While the lawmakers aren’t proposing an all-out repeal of the tax, the measure would be the third delay of the assessment. Reps. Kristi Noem (R-SC) and Jackie Walorski (R-IN) co-sponsored the bill along with Reps. Kyrsten Sinema (D-AZ) and Ami Bera (D-CA). Insurers must pay the tax for 2018, though it was suspended in 2017, and Congress passed another moratorium for 2019. Insurers estimate it will cost them $14.3 billion this year, which is largely passed on to consumers in the form of higher premiums.

Based on a 2012 Supreme Court case, the only basis for the individual mandate’s constitutionality, according to Chief Justice John Roberts, is that the mandate is a tax — not a fine, penalty, or anything else. This is a vital point because when Republicans passed their tax reform legislation in December 2017, they included a provision that lowers the individual mandate penalty to $0 beginning in January 2019. That means the individual mandate no longer could be considered a “tax” and therefore is unconstitutional.

U.S. Sens. Chris Murphy (D-CT) and Jeff Merkley (D-OR) recently introduced the “Choose Medicare Act” which would give every American the option to buy into Medicare. Their colleagues have already rolled out three other bills that would provide for a more limited Medicare buy-in, a Medicaid buy-in, and a full-fledged, government-run, single-payer system. All of these bills would lead to the same inevitable outcome—a federal takeover of the nation’s healthcare system. Each of the government-sponsored buy-in plans could operate at a loss indefinitely. Private insurers don’t have that luxury; they’d ultimately go out of business.

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Updated on 6/4/18